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Decla~ation o! Domicile and Citisenship
TO THE STATE ANO COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile end Citizenship in the State of Flo~ida that I am filinq this day in acoordence and
~n conformity with Chapter 2~2, Section 222.17, Florida Statutes.
GILBBRT W. VA.
1 was farmerly a lega) resident of _
(CitY) (Staro)
t
~jUStiCC ~ W. V8. ~M,ever 1 have charped my domi~jle
and I tesided at _
(St~eet and Numbe~)
to end am arx! have been a bona fide resident of the State of Florids since 8t~ day of
~
January 68 2251 N. Federal H-wa y ~
- . 19 , and 1 ~eside at '
' (Stree! and Number) !
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my detlaration of citizenship, actval legal residence bnd domiale in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILING TO ENPBR CHILD IN PUBLIC SCHOC?L
FILEO AND RECORDED
ST.RE CORO VuR FYFDLA.
'68 JAN 12 P~I 2 :09
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CLERK CIRCUIT COUR7 f
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1 RIRTHER CFRTIFY that 1 will oomply with al) other requirements of a le~al resident of this State. ~
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1 FURTHER CERTiFY that I have no intention to return to my former dom~~jle, and 1 intend to remain in FORT ~
{
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
_ ~
1 • (Name)
' ~ ~ ~ ARDFN A. WALIS
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~ ~c 12 January
' ~7. 68
; i$'"~to a~d subscribed before me this day of , ~q
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~'~~~lii fT COURT Notary Public
BY D.C. My ~ommission expires
(To b~ ~x In duplicab ~nd oriainal ~ibd with Cl~rlc Cirarit Courl, and duplicah with Tax Asts~or.)
~0~169 ~2981 '
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